TABLE 1.

ISQIC Colorectal SSI Reduction Bundle

Preoperative (outpatient)

1. Oral antibiotics (eg, oral erythromycin, neomycin, metronidazole)*

2. Mechanical bowel preparation (eg, large-volume polyethylene glycol)*

3. Preoperative chlorhexidine skin cleansing day before surgery (eg, shower, wipes)

4. Preoperative chlorhexidine skin cleansing day of surgery (eg, shower, wipes)

Preoperative (inpatient)

5. Timely initial administration of appropriate intravenous SSI antibiotic prophylaxis (Appendix A)

6. Same-day, preoperative day-of-surgery blood glucose < 200 mg/dL for ACS-NSQIP-defined diabetics

Intraoperative (surgery)

7. Timely intraoperative redosing of appropriate SSI antibiotic prophylaxis (Appendix B)

8. OR traffic limited to essential personnel†

9. Surgical site hair clipping (no shaving)†

10. Proper wound classification†

11. Proper hand hygiene for all OR providers involved in patient caret†

12. First measured temperature on arrival to PACU is ≥ 36.0°C/96.8° F

13. Intraoperative skin preparation with chlorhexidine and alcohol-based solution(s)

14. Impermeable wound protector utilization for all incisions

15. Utilization of a dedicated clean wound closure tray/instruments

16. Gown and glove change for all scrubbed personnel prior to wound closure

17. Redraping prior to wound closure

18. Sterile occlusive incisional wound dressing placed in OR

19. Intraoperative blood glucose at 2h (+/− 30 min) into surgery < 200 mg/dL for AC S-NSQIP-defined diabetics

Postoperative (inpatient)

20. Duration of intravenous antibiotic prophylaxis is less than 24 h

21. Removal of the original operating room incisional dressing on postoperative day 2

22. Daily chlorhexidine incision cleansing after dressing removal until discharge (but not to exceed postoperative day 7)

^*ACS-NSQIP defined process measure.

^†Policy measure, data not abstracted.